Intracranial actinomycosis

Intracranial actinomycosis is rare bacterial infection without any characteristic clinical or radiological diagnostic features. Usual presentation is like pyogenic brain abscess, osteomyelitis with or without pachymeningitis and rarely as a parenchymal mass lesion. High index of suspicion should be kept in a patient with immunosuppression or predisposing factors like dental procedure, sinusitis, cardiac septal defects, cranio-facial trauma, cranial surgery, lung or abdomino-pelvic infection.

CASE DESCRIPTION: We present a case of right parietal parenchymal lesion with involvement of the calvarium as well as pericranium, in a young female without any predisposing factor. She underwent complete microsurgical excision of the lesion followed by prolonged antibiotic therapy with good functional recovery.

CONCLUSION: Intracranial actinomycosis presenting as a parenchymal mass lesion is extremely rare as compared to abscess and pachymeningitis. Histopathological examination remains the mainstay of definitive diagnosis, as culture might be negative in significant number of cases. Aggressive surgical excision with prolonged antibiotic therapy enhances the chances of good functional outcome ¹⁾.